Provider Demographics
NPI:1518318856
Name:LAS VEGAS MT76 INC.
Entity Type:Organization
Organization Name:LAS VEGAS MT76 INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-994-6634
Mailing Address - Street 1:1101 MIRANDA LN
Mailing Address - Street 2:SUITE 131
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-0769
Mailing Address - Country:US
Mailing Address - Phone:407-994-6634
Mailing Address - Fax:407-350-4109
Practice Address - Street 1:1101 MIRANDA LN
Practice Address - Street 2:SUITE 131
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0769
Practice Address - Country:US
Practice Address - Phone:407-994-6634
Practice Address - Fax:407-350-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL158002347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle